Health Care

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Foley & Lardner LLP: CMS Proposes Major Update to Medicaid Managed Care Regulations
Posted on 3 Jun 2015 by Foley & Lardner LLP

By Anil Shankar and Adam J. Hepworth The Centers for Medicare and Medicaid Services (“CMS”) released, on May 26, 2015, the a far-ranging proposal for revising the Medicaid managed care regulations (“ Proposed Rule ”). The number... Read More

DLA Piper Health Systems Alert: Payment-Driven Transformation Ahead For U.S. Healthcare
Posted on 1 Jul 2015 by DLA Piper

By David Gruber, MD, MBA* Healthcare spending is forecast to increase from US$3 trillion in 2014 to US$5.2 trillion in 2023, reflecting a compound annual growth rate of 5.9 percent. US healthcare expenditures on a per capita basis are 1.9-2.6 times... Read More

Norton Rose Fulbright: Physicians Payments Sunshine Act Data 33 Percent Unpublishable, Penalties Next?
Posted on 19 Aug 2014 by Norton Rose Fulbright

By Benjamin Koplin , Selina Coleman and R. Jeffrey Layne Despite extending the dispute-and-resolution deadline to account for the days that the Centers for Medicare & Medicaid Services (CMS) pulled down the reporting system, the public Physician... Read More

Barnes & Thornburg LLP: Antitrust Enforcement For Market Allocation By Michigan Hospitals
Posted on 7 Jul 2015 by Barnes & Thornburg LLP

By Julie Veldman On June 25, 2015, the United States Department of Justice (DOJ) and the Michigan Attorney General (Michigan AG) sued four Michigan hospital systems for entering into agreements with a competitor to unlawfully allocate territories for... Read More

Steptoe & Johnson PLLC: Physicians in Whistleblower Suits Need Not Exhaust Peer Review Remedies
Posted on 27 May 2014 by Steptoe & Johnson PLLC

A recent decision of the California Supreme Court removed a long-standing procedural limitation on physician suits against hospitals arising from peer review actions. In the recent decision, the California Supreme Court held that a physician need not... Read More

Williams Mullen: Health Care Providers Lacked Standing to Sue as ERISA Beneficiaries: Rojas v. Cigna Health and Life Insurance Company
Posted on 28 Jul 2015 by Williams Mullen

By Mark S. Thomas The U. S. Court of Appeals for the Second Circuit has affirmed a dismissal of claims by two physicians and their medical practice asserting standing under ERISA to enjoin an insurer from removing them from its coverage network. Rojas... Read More

Steptoe & Johnson PLLC: 4th Circuit Rules CON Statute May Discriminate Against Providers
Posted on 21 Nov 2013 by Steptoe & Johnson PLLC

By Gordon H. Copland | A recent decision suggesting that the Virginia Certificate of Need (“CON”) law may be unconstitutional has widespread implications for CON laws around the country, including West Virginia and Kentucky. The surprising... Read More

Barnes & Thornburg LLP: OIG Work Plan 2014: Takeaways for Hospitals
Posted on 21 Feb 2014 by Barnes & Thornburg LLP

By Gayland Hethcoat With the release of its work plan for fiscal year 2014 on Jan. 31, 2013, the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) has provided insight on the agency’s current enforcement... Read More

Norton Rose Fulbright: OIG Releases FY 2014Work Plan Summary
Posted on 11 Feb 2014 by Norton Rose Fulbright

By Frederick Robinson , Megan Fanale Engel , Cori Annapolen Goldberg and Selina Coleman On January 31, 2014, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published its Work Plan for fiscal year 2014. The OIG announced... Read More

Barnes & Thornburg LLP: HIPAA Settlement – Improper Storage Of EPHI
Posted on 16 Jul 2015 by Barnes & Thornburg LLP

By Stacy L. Cook On July 10, 2015, the Office for Civil Rights (OCR) announced a HIPAA settlement with St. Elizabeth’s Medical Center (SEMC), a tertiary care hospital in Brighton, Massachusetts. SEMC has agreed to pay $218,400 and adopt a robust... Read More

Norton Rose Fulbright: CMS Offers Settlement Of Inpatient RAC Denials
Posted on 24 Sep 2014 by Norton Rose Fulbright

By Mark Faccenda On August 29, 2014, the Centers for Medicare and Medicaid Services (“ CMS ”) announced that certain providers with pending appeals of specified inpatient-status claims denied by Medicare contractors may elect to receive... Read More

Barnes & Thornburg LLP: President Obama Signs Bill Extending Physician Medicare Rates And Delaying ICD-10 And RAC Audits Under The 2-Midnights Rule
Posted on 8 Apr 2014 by Barnes & Thornburg LLP

By Nita Garg On April 1, President Obama signed the Protecting Access to Medicare Act of 2014. This legislation extends current Medicare physician reimbursement rates and delays implementation of the ICD-10 code for a full year. Previously, hospitals... Read More

DLA Piper: Federal Court Blocks Rule Restricting Telemedicine Practice In Texas
Posted on 30 Jun 2015 by DLA Piper

By Nathan Fish and Frank E. Sheeder A federal court has temporarily enjoined the Texas Medical Board (TMB) from implementing and enforcing a rule restricting the practice of telemedicine pending resolution of an antitrust lawsuit filed by Teladoc,... Read More

Williams Mullen: OIG 2014 Work Plan Focuses On Compounded Pharmaceuticals Reimbursed By Medicare
Posted on 14 Feb 2014 by Williams Mullen

By Brian C. Vick The Office of Inspector General for the U.S. Department of Health and Human Services (“OIG”) included two items in its recently-released 2014 Work Plan indicating a new focus on the quality and safety of compounded pharmaceuticals... Read More

Barnes & Thornburg LLP: Amarin Pharma Preemptively Sues FDA over 1st Amendment Rights
Posted on 22 May 2015 by Barnes & Thornburg LLP

On Thursday, May 7, Amarin Pharma took the unprecedented step of proactively suing the U.S. Food and Drug Administration (FDA) over the agency’s alleged infringement of the company’s First Amendment Rights. The case arises from Amarin’s... Read More